Provider Demographics
NPI:1306185913
Name:ILLINOIS PAIN SPECIALISTS, LLC
Entity type:Organization
Organization Name:ILLINOIS PAIN SPECIALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-307-3009
Mailing Address - Street 1:1000 RANDALL RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2590
Mailing Address - Country:US
Mailing Address - Phone:630-845-4099
Mailing Address - Fax:630-845-4098
Practice Address - Street 1:1000 RANDALL RD
Practice Address - Street 2:SUITE 225
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2590
Practice Address - Country:US
Practice Address - Phone:630-845-4099
Practice Address - Fax:630-845-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089505208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115220OtherMEDICAL LICENSE